Lawsuits, rulings and settlements: 7 recent payer legal updates to know

From rulings that could strike down preventive care requirements, to Medicaid fraud settlements, here are seven recent legal updates involving payers Becker's has reported on since Sept. 1. 

1. A federal judge in Texas ruled in favor of a Texas employer who said providing coverage for HIV-prevention drugs, known as PrEP, violated religious freedom. The Sept. 7 ruling was a partial victory for opponents of the ACA's preventive care requirements, which mandate payers cover proven preventive care at no cost. A final ruling in the case is likely far off, with appeals of the ruling expected in higher courts.
   
   
2. LGBTQ and health advocacy groups filed a lawsuit challenging Florida's ban on providers billing Medicaid for gender-affirming care,The Washington Post reported Sept. 7. The lawsuit says the state's policy violates constitutional rights and federal nondiscrimination laws. 
   
   
3. UnitedHealthcare and Nashville, Tenn.-based Envision Healthcare filed lawsuits against each other over disagreements about emergency care payments, Becker's reported Sept. 9. Envision Healthcare, a physician services company, sued the payer over allegations it engaged in an unlawful scheme to deny emergency room claims for high-need patients. The two organizations have been out-of-network since Dec. 31, 2020. 
   
   
4. The American Medical Association and other advocacy groups joined a class-action lawsuit against Cigna Sept. 12. The suit was originally filed by Cigna members in June, alleging the payer engaged in a scheme to underpay claims and increase administrative fees. 
   
   
5. Anthem Blue Cross and Blue Shield said it is reviewing its options after a panel of Kentucky appellate judges upheld the state's 2020 managed contract awards, the Louisville Courier-Journal reported reported Sept. 15. The payer sued after it was not chosen as one of the five contractors for the state's managed care program. Parties involved in the dispute have 30 days from the court's Sept. 9 decision to file an appeal. 
   
   
6. UnitedHealth won a class-action lawsuit that alleged the payer did not pay physicians facility fees for office-based surgeries, Bloomberg Law reported Sept. 15. The judge ruled in favor of UnitedHealth, saying none of its health plan documents "clearly required" the company to pay those fees.
   
   
7. Centene will pay $165.6 million to the state of Texas to settle an investigation into if the payer violated Medicaid fraud laws, the Texas Attorney General's office said Sept. 19.  Texas is at least the 12th state Centene has paid settlements to over allegations it overcharged state Medicaid providers for prescription drugs and services.